The meical records of 28 patients treated for choledochal cysts from 1975 to 1990 were reviewed and long-term follow-up results were evaluated based on the type of cyst and the choice of surgical procedures. This summary details and 15 years of
experience ranging from newborn (4 months) to 70 years of age. We divided these patients into two groups a group of children (below 15 yrs) and an adult group (above 15 yrs). The diagnosis was made in all patients using ultrasound,
cholangiography,
hepatobiliary CT scan, and ERCP. Of 28 patients, 23 (89%) were female and 5(11%) were male. In the analysis of clinical finding, 19 patients(68%) presented with abdominal pain in the right upper quadgrant, 8 patients(29%) with jaundice, and 5
patients(18%) with an abdominal mass. Only 1 patients(3.6%) presented with the classic symptom triad. According to the Todani classification system, 18 patients(64%) had type I, 4 patients (14%) had type II, and 5 patients(18%) had type IV.
Stones
were
present in 4 adult patients and all excised cysts were benign at the time of initial operation. In the childrens group, 6 patients received internal drainage procedures as choledochocystoduodenostomy in 5 and cystojejunostomy in 1. Ten patients
received
definitive management as complete excision of cyst with choledochojejunostomy (Roux-en-Y) in 4 and hepaticojejunostomy (Roux-en-Y) in 6 Contrariwise, in the adult group, 9 cases received complete dexcision of cyst with choledochojejunostomy in 4,
hepaticojejunostomy in 4, and Y-tube choledochostomy in 1, and 2 cases received partial excision with choledochojejunostomy. In 2 patients who had undergone partial excision of cyst, one patients developed cholangitis and the other patient had
developed
cholangiocarcinoma in remnant cyst and cholangitis. Another patient who had received excision of cyst with choledochojejunostomy developed cholangiocarcinoma arising above the anastomotic site. There was one hospital death in a 6 month old infant
after
undergoing complete excision of cyst. The follow-up period ranged from 6 months to 15 years. In those with carcinoma, is occurred within 3 years after original operation. Thus, the best procedure for choledochal cyst appears to be complete
excision
of
cyst and Roux-en-Y hepaticojejunostomy.
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